• DXT/Reflo<4
• Omit insulin.
• Encourage orally (sweets,bread with jam)
• DXT<3 with symptoms, give 20-50cc D50% then repeat DXT after 30 minutes.

• DXT>20
• Look for DKA symptoms.
• Give IV 6-10 unit actrapid STAT.
• If symptomatic, TRO DKA. Take VBG, urine ketone.

• Examine lungs & SpO2

• Determine causes

• If intubated, check if ETT dislodged or too deep

• Start NPO2/FM/HFM.

• If known case of COPD to start VM.

• Keep SpO2 >95%.

• If rhonchi – Neb salbutamol or combivent STAT, IV hydrocortisone 200mg STAT.

• If significant SOB with SpO2 drop, take ABG.

• Inform MO

• Manual bagging 15L/min (even for ventilated patient)
• Straighten bed & commence CPR
• Inform MO
• Transfer acute
• Vital signs, DXT & cardiac monitoring
• 2 large bore branulas at least pink
• Run 1 pint NS fast if no contraindications
• Prepare IV adrenaline (1mg every 5 mins)
• Prepare intubation kit
• Keep bp >90/60, map >65.
• Strict I/O via CBD
• For inotropes if low BP
• IV Ranitidine 50mg TDS to prevent gastric ulcer
• RTF, start clear fluid 50cc & increase accordingly (increasee 50cc if tolerates x3 to max of 300cc). Refer dietician.

• BP<90/60 or MAP <65.
• Determine causes: sepsis, UTI, hypovolemia, cardiogenic etc.
• Run 1 pint NS fast if no contraindication such as fluid overload.
• If still low, for another try and inform MO.
• IVI noradrenaline (inotrope) if BP is still low & adjust accordingly.
• BP monitoring every 30 minutes.
• KIV add another intrope if low despite high dose 1st inotrope.

• K+ = Potassium <2.5
• ECG STAT to look for hypokalemic changes.
• 1g KCl in 100cc NS in 1 hour or 2g KCl in 200cc NS over 2 hours (according to K+ level) with continouos cardiac monitoring.
• Add KCl in drip if any, mist KCl 15ml TDS / Tab Slow k 600mg/1.2g OD.
• K+>4: Off K supplements.
• RP 1 hour post correction
• RP CM

Calculation

K+ Requirement = Deficit + Maintenance

Deficit =「 (4 -patient’s K) x weight x 0.4 」divided by 13.3

Maintenance = weight divided by 13.3

Add both = Requirement to correct

Example:

• Patient requires 5g of potassium
• Patient is on 2pint IVD
• Add 1g KCl per pint and oral supplementation mist KCl 1g TDS (Total: 2g + 3g = 5g)

⛔️ Caution given to ESRF patient

• K+>5.5
• ECG STAT to look for hyperkalemic changes.
• Perindopril can cause hyperkalemia.
• Off K supplements.
• Lytic Cocktail.
• Oral kalimate 5-10g TDS.
• Off kalimate once K+<5
• K+ 1 hour post correction
• RP CM

Lytic Cocktail

1. 10cc of 10% calcium gluconate in 10 minutes with cardiac monitoring (10 minutes)
2. 50cc D50% glucose
3. 10 unit Actrapid

• ECG STAT.
• Inform MO.
• Vital signs.
• If BP stable (>90/60), S/L GTN, maximum 3 times.
• If persistent pain to start IV Morphine with IV Maxolon.
• If persists, start IVI GTN.
• Take troponin earliest 3 hours post chest pain.

• Left lateral
• Remove dangerous objects
• High flow mask 10L/min
• Vital signs & DXT
• Inform MO
• Insert branula
• Monitor vital signs, fit, GCS, behavioral & alcohol chart (if relevant)

• Vital signs & DXT

• Inform mo

• Transfer acute

• Determine causes

• Approach calmly

• Ask help from security guards or male staff

• Inform MO

• IM haloperidol 5mg STAT

• 4 point restraints

• Refer PSY

• Get a sample of vomit if possible

• PR examination to look for malenic stool

• Vital signs to look for compensated or decompensated shock

• Inform MO.

• If significant blood loss to insert 2 branula with FBC, RP, coag profile & GSH.

• IV tranexamic acid 1g STAT, then 500mg TDS.

• IV pantoprazole 40mg.

• If worsens, KIV IVI Pantoprazole.